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� Sec.13.04 RIGH'TS OF SUB.TECTS OF DATA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency, poli6cal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supp(ying or refusing to supply private or confidendal data;and(d)the identiry of other persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesaeadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the notice reauired under this subdivision in the individual income tax or_property tax refund instructions insread of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, private or confidennal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any charge to him and,�if he des'ues, shall be informed of the content and meaning of that dara. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secrion is pending or addidonal data on the indi.idual has been col(ected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require ihe requesting person to pay the actual costs of making, certifying,and compIling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform che individuai,and may have an addirional five days within which to compiy with the request,excluding Saturdays, 5undays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall noafy in wridng the responsible authoriry describing the nature of the disagreement. The responsible auchoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to norify past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included wi[h the disclosed data. The determina[ion of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relaang to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1, The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. �� I� l��--�� I��, �l��r�� First � �ldn� Last `?�/�)� / s� . vt A ress � s S ��-��,�1-�/� �;�ti. S�� z� 3Q�-� � Ciry State Zip Phone I understand my rights as stated above. /�r,� �� --� Signature